Search

Muscle cramps are suddenly occurring involuntary, mostly painful contractions of a single muscle, rarely of a muscle group. They can be idiopathic or occur in various neuromuscular diseases and can sometimes substantially impair the quality of life due to the frequency and strength. Only a few drugs are available for the effective treatment of cramps.In this case series we report on five patients with cramps of different origin who responded well to treatment with brivaracetam.Brivaracetam is actually used for the treatment of epileptic seizures. It binds to the synaptic vesicle protein 2A (SV2A), which also occurs in nerves and nerve roots. The SV2A regulates the exocytotic release of neurotransmitters, which could explain the effect of brivaracetam on muscle cramps.Further studies are needed to demonstrate the effect of brivaracetam on muscle cramps.

The present review focuses on the cramp-fasciculation syndrome, a benign disorder which is regarded as a hyperexcitability syndrome of the peripheral nervous system. The article presents clinical features, pathophysiology, differential diagnosis, therapy and a case report to illustrate the cramp-fasciculation-syndrome.Die vorliegende Übersichtsarbeit beschäftigt sich mit dem Myalgie-Faszikulations-Krampus-Syndrom (MFKS), einer gutartigen Erkrankung, die zu den Hyperexzitabilitätssyndromen des peripheren Nervensystems gezählt wird. Der Artikel stellt die Klinik, Pathophysiologie, Differenzialdiagnostik und Therapie dar und illustriert das MFKS mit einem typischen Fallbericht.

Muscle pain as a common symptom in daily practice frequently occurs as a non-specific accompanying symptom in multiple internal and neurological diseases. Primarily inflammatory or autoimmune muscular diseases are causing muscle pain. However, a number of non-inflammatory causes of pain can also be considered for differential diagnosis. These are presented in this article. In principle, a distinction must be made between focal and diffuse muscle pain. As an invasive diagnostic procedure, a muscle biopsy should only be performed as the last step in the diagnostic alogorithm. If diffuse muscle pain is only associated with slight muscle weakness or is completely absent, there is usually a primary rheumatic cause. Statins (HMG-CoA reductase inhibitors) can lead to rhabdomyolysis, muscle fiber atrophy and muscle necrosis by damaging the muscle fiber membrane. Myotonias are autosomal dominant or autosomal recessive inherited disorders of muscle function. The genetic defect leads to pronounced muscle stiffness. The cause of metabolic myopathies can be disorders of the carbohydrate, fat or purine metabolism. Fibromyalgia syndrome (FMS) is a non-inflammatory disease and, according to the current knowledge, recognized as the result of an exposure to physical, biological and psychosocial factors (biopsychological disease model). To help diagnosing FMS, pain regions and core symptoms (fatigue, sleep disturbances) can be detected using questionnaires (Widespread Pain Index [WPI] and Symptom Severity Scale [SSS]).

Frequent and painful nocturnal leg cramps (NLC) require an effective therapy to improve quality of life and sleep performance in patients.In a multicenter, prospective, non-interventional study (NIS) data on the effectiveness, tolerability and safety of quinine sulfate were collected in daily medical management in adult patients with frequent and painful nocturnal leg cramps.In total 596 patients were included into the study. Of these, 568 patients finished the study as planned (95.3%). Number, duration and pain intensity of NLC were reduced in the majority of patients after 2 weeks of therapy with quinine sulfate 200 mg OD. Physicians rated global assessment of treatment effect as "good" and "very good" in 535 patients (92.4%) which was concurrent with the patients' rating ("good" and "very good" by 534 patients = 92.2%), based on the full analysis set of 579 patients. Furthermore, quality of life and sleep were improved. Adverse drug reactions were reported in 35/592 patients (5.9%). Severe adverse events were not observed. The total incidence of therapy-associated adverse effects was comparable in the subgroup of patients with concomitant ß-blocker therapy (149/592 patients, 25.2%; totally 10%, subgroup 10.1%). Efficacy and tolerability of quinine sulfate were evaluated as "very good" or "good" by the majority of physicians and patients.The present NIS confirms effectiveness and tolerability of the therapy with quinine sulfate in daily clinical routine for adult patients with frequent and painful nocturnal leg cramps.

Muscle cramps are common in the population, especially in athletes. However, various ideas exist as to how to treat cramps. The aim of this investigation is to compare and contrast the common conceptions with the results of evidence-based studies. Scientific literature research. The knowledge of the population seems insufficient and does not reflect the current scientific evidence. It is necessary to spread current scientific knowledge among the population, especially via coaches and doctors acting as multipliers. Muskelkrämpfe sind weit verbreitet in der Bevölkerung, gerade auch bei Sportlern. Viele haben ihre Vorstellungen, was dagegen helfen könnte. ZIEL: Abgleich zwischen den therapeutischen Vorstellungen der Menschen, vornehmlich Sportlern, was sie gemeinhin bei Muskelkrämpfen als hilfreich erachten und der durch Studien belegten Wirksamkeit. Literaturrecherche. Die Studienlage unterscheidet sich deutlich vom „Halbwissen“ der Teilnehmer. Mit Halbwissen sollte aufgeräumt werden, und aktuelles, wissenschaftlich belegtes Wissen muss sich, gerade auch über Multiplikatoren wie Trainer, Ärzte etc., in der Bevölkerung verbreiten.

Cramps are painful sensations caused by intense involuntary contractions of skeletal muscles, mostly in the calves, usually lasting from a few seconds to several minutes. Although cramps are mostly idiopathic, theycan bea symptom of other forms of myalgia, restless legs syndrome or spasticity. Especially nocturnal cramps can cause considerable distress for patients requiring fast pain reduction and effective prophylaxis. Stretching the calf muscles helps preventing nocturnal cramps. Pharmacological treatment of leg cramps includes magnesium and quinine.

Hypokalemia is a common finding. The clinical presentation can be paralyses and cardiac arrhythmias. We present a normotensive young woman with salt appetite, cramps and palpitations. In our case report the patient shows a positive family history for hypopotassemia, a metabolic alkalosis with hypotension, and hypocalciuria with an increased urinary potassium loss. The levels of renin and aldosterone were elevated. After a negative testing for metabolites of diuretics, we obtained a positive result of the suspected SLC12A3 genetic test. This mutation leads to a failure of the thiazide-sensitive sodium-2-chloride-cotransporter, the so called Gitelman syndrome, which presents similar to a chronic thiazide therapy. The Gitelman syndrome is a rare disease with renal potassium loss and hypotension. Especially in young patients around the age of twenty or in patients with chronic intractable hypopotassemia a Gitelman syndrome should be considered.

Calf cramps are sudden, involuntary, painful contractions of part of or the entire calf muscle that are visible, persist for seconds to minutes and then spontaneously resolve. They can occur with no identifiable cause, and are then referred to as common calf cramps. They may also be symptoms associated with diseases of the peripheral and central nervous system and muscle diseases. They also occur in association with metabolic disorders. In such cases the cramps are more extensive, intense and persist for longer. Cramp-fasciculation-myalgia syndrome additionally involves paresthesias and other signs of hyperexcitability of peripheral nerves. The recommended treatment for patients with frequent calf cramps causing significant impairment of well-being is oral administration of quinidine and/or botulinum toxin treatment of the calf muscles. During pregnancy both products are contraindicated, while probatory administration of magnesium is indicated.

Granulomatous myositis is a rare neuromuscular disorder histologically characterized by the development of endomyseal and/or perimyseal granulomas. Clinical hallmarks are generalized muscle weakness, myalgias, and bulbar symptoms. The association of granulomatous myositis with sarcoidosis is well known; less recognized is the association with several infectious diseases, inflammatory bowel diseases, malignancy, thymoma, graft-vs-host disease, and myasthenia gravis. In absence of sarcoidosis or other underlying disorders, the diagnosis of isolated or primary granulomatous myositis must be considered. Therapeutic strategies focus on immunosuppression, whereas the therapy response is unpredictable. Here we discuss the clinical features, diagnosis, and differential diagnosis and therapeutic strategies of primary and secondary granulomatous myositis.

Popliteal vein entrapment must be taken in consideration in patients with symptoms of venous insufficiency. Leg edema, swelling, calf pain, and muscle cramps are all unspecific signs. Most patients thus far have presented with deep vein thrombosis or chronic venous insufficiency. Popliteal entrapment syndrome must be taken into account in younger patients in whom predisposing factors are absent and chronic calf swelling is notable. Diagnosis is easily confirmed by noninvasive stress testing with duplex imaging and pencil Doppler probe placed over the posterior tibial artery. Additionally, digital subtraction angiography with the foot in neutral and dorsi plantarflexion is recommended for arterial entrapment. Surgery is advisable for treatment and can be done without significant morbidity. In asymptomatic patients, we suggest using the term "popliteal vein entrapment phenomenon." We describe different etiologies of popliteal vein entrapment in three cases and present a review of the literature.

Eccentric muscle work is an important part of our everyday activity, i.e. in breaking and preventing falls. Eccentric phases of movements improve the efficiency of cyclic repetitive activities. The molecular function in eccentric work is not understood, however its characteristics are a low metabolic demand and a high power output. Compared to concentric work there are only small differences in the hemodynamics of eccentric work. The muscle capacity for mechanical load is the limiting factor in eccentric work. Unaccustomed eccentric activity leads to damage of the cytoskeleton, which is the reason for delayed onset of muscle soreness. In sports and rehabilitation eccentric training can result in significant strength gain. Its use is today established to improve structures, which are exposed to eccentric loads in everyday activity. The high mechanical power may be promising in the musculoskeletal rehabilitation of patients with cardiopulmonary limitations.

The symptoms of epileptic seizures in old patients differ from those in younger patients. Therefore, these seizures may be misinterpreted as symptoms of other "typical" diseases in old people. In an old people's home, we assessed whether a standardized questionnaire is able to reveal undiagnosed epilepsy in the elderly. Reported sudden falls, loss of consciousness, and cramps were the criteria for further diagnostic procedures. We found epilepsy in 11 of 389 study participants. In four of them (1% of the total sample), the epilepsy was newly diagnosed; five more cases remained unclear. Therefore, the total number of epileptic patients might have been even higher. Most of the reported sudden falls and unconsciousness (89%) were due to internal medical or other neurological or orthopaedic causes. Once these have been excluded, the diagnosis of epilepsy should be considered. The results of our pilot study suggest that epilepsy in old people's homes is often unrecognised. Early diagnosis and treatment of epilepsy in the elderly is important to improve prognosis and social consequences for affected persons.

A 26-year-old woman presented with fatigue, muscle cramps and weakness. Since the age of 8 years she had moderate hypokalemia of unknown origin that was confirmed on multiple occasions. There was no family history of disease.Laboratory tests showed moderate to severe hypokalemia with a serum potassium concentration of 2.7 to 3.0 mmol/l, hypomagnesemia, metabolic alkalosis and pronounced stimulation of the renin-angiotensin-aldosterone system. Despite normal serum calcium levels, urinary calcium excretion was below the detection threshold. Increased natriuresis was observed after administration of furosemide, but not after administration of hydrochlorothiazide. This finding pointed to the presence of a non-functional thiazide-sensitive sodium/chloride cotransporter in the distal convoluted tubule, characteristic for Gitelman's syndrome. Genetic analysis confirmed the diagnosis of Gitelman's syndrome and documented two heterozygous mutations in the gene encoding the sodium/chloride cotransporter.The patient was treated with 160 mmol potassium and 30 mmol magnesium supplementation per day. Serum potassium was normalized and magnesium serum levels increased. Weakness and fatigue improved markedly.Gitelman's syndrome is an important differential diagnosis in the evaluation of the normotensive patient with hypokalemia.

The case of a 30-year-old male, who presented with a three months history of fever, night sweats, weight loss and myalgia is reported. Subsequently abdominal cramps, bloody diarrhea and mononeuropathy multiplex developed. An abdominal and renal angiogram showed changes of vascular structures diagnostic for polyarteritis nodosa. An immunosuppressive treatment (Prednisolon 100 mg/day and Cyclophosphamid 200 mg/day) was started. However, diffuse peritonitis as the aftermath of bowel infarction, which comprised the total length of the jejunum and the proximal parts of the ileum, developed at the third week of this treatment. Despite immediate surgical resection of the ischemic bowel septic complications occurred and the patient died.

The basic scientific knowledge about stretching remains incomplete in spite of its wide use in sports and physiotherapy. This article deals with the assessment of the flexibility and with the anatomical and physiological basis and limitations of stretching. The effects of stretching on delayed onset muscle soreness (DOMS), performance and regeneration are discussed. Recommendations are given for stretching as a measure of warming-up and cooling-down, for stretching before exercises, which demand explosive maximum muscle strength, and for stretching after training for strength endurance.

The objectives of this work were to cause the Glässer's disease (GD) in primary specific pathogen free piglets after experimental infection, to observe the clinical symptoms and to examine the influence of the infection on the haematological parameters. GD was caused by experimental infection of Haemophilus parasuis in seven to eight weeks old specific pathogen free piglets. In relation to the infection route the morbidity was high (83-100%) and 20% of the infected piglets died. Based on the physical examination fever, respiratory distress, cramps and paralysis were observed which are typical for GD. Arthritis and nerval symptoms are also typical but less common in Glässer's disease. PCV was significantly decreased and WBC significant increased before the piglets were euthanatized.

Muscular spasm is a frequent symptom which is difficult to record precisely. On the basis of literature on the subject and of own studies, we undertook to describe various methods of examination which could be used to demonstrate such changes. Up to now, palpation is still the most important and most exact method for the experienced examiner. In this way local as well as extended muscular spasms can be made evident. The disadvantage however is the lack of objective proof. The easy-to-use Tissue-Compliance-Meter of Fischer, which measures the consistency of soft tissue, documents the intraindividual difference rather than the interindividual difference. This is due to the individually variable thickness of the subcutaneous fatty tissue. However, on the whole there is a good correlation to the findings of palpation. The pendulous-test and badismography allow especially the conclusion with regard to unilateral changes of tonus in the gluteal and upper leg muscles. This method also very well suits the intraindividual comparison, but less so the interindividual one. The continuous electromyogram is able to show the enhanced activity in spasmotic muscles also during sleep. The evaluation of enhanced muscle activity remains uncertain when using plain electromyogram. Recording of muscle tissue oxygen pressure is of little use to evaluate muscle spasm. Nonetheless, it provides interesting insights into pathogenetic questions. Thermography, measuring the blood circulation at the skin surface, is especially suited for perceiving intraindividual differences in case of muscle spasm. Nuclear magnetic resonance spectroscopy allows for noninvasive pH measurements in the muscle and therewith renders certain data concerning the degree of tension of this tissue. It is not yet suited for routine examination. The value of positron emission tomography for registering muscle spasm remains uncertain. Hopefully, this method, which documents the muscle energy metabolism, will enable us to more clearly evaluate muscle spasm than previous methods have done. Light and electron microscopic studies have provided contradictory results concerning histological changes in muscle biopsy in case of muscle spasm.

30 patients with writer's cramp were examined by a neurologist and a psychiatrist. The syndrome was frequently associated with a postural tremor. We found no evidence for a peripheral causation. Electromyographical recordings showed co-contractions of agonists and antagonists as well as individual patterns of increased muscle activity during writing. CT and MRI scans were normal in most patients. The psychiatric examination revealed a history of situational stress at the onset of the disease and also some abnormalities in the biography and personality traits. Since the latter findings were not consistently present we have no evidence that the disease is a neurotic manifestation. We consider it likely that secondary psychoreactive processes may have some significance in the individual patient.

As there is a variety of psychic and somatic variables in its genesis, the writer's cramp could be a syndrome of different subtypes. Therefore 62 former psychotherapy-patients with writer's cramp were examined according to a design of several dimensions in order to find out if there were any subtypes. The parts of the examination were exploration, structural interview, neurological examination, psychological examination of the personality, examination of some electrolytes in serum and radiograph of neck spinal column. Different multivariate statistical methods isolated two subtypes of patients with writer's cramp. The first group comprises patients with fine and/or big dysfunctions of motor activity, the symptoms are independent of psychic factors or of psychotherapy. The second group is characterized of a monosymtomatic writer's cramp, of a neurosis and of remissions of motoric symptoms following psychotherapy. The examination shows that fine and/or big dysfunctions of motor activity which often co-occur the writer's cramp are important criteria for differential diagnosis and indications.

In recent publications writer's cramp is mostly seen as a "focal dystonia", which denotes a group of organic-degenerative disorders of the basal ganglia. In opposite to this view psychoanalysts have pointed out since many years the psychogenesis of the syndrome. Our investigation starts with the descriptive analysis of three own cases. It will be shown how clinical facts present a complex situation, which allows the hypothesis, that somatic and psychogenetic factors coincide in the pathogenesis of occupational cramps. Finally a proposition is made how empirical evaluation of the hypothesis is possible.

In preparing for competitive body building, body builders--in addition to continuous and hard muscle training--engage in stringent dietetic manipulations: the first few months of hypercaloric nutrition, rich in proteins, are devoted to the build-up of muscle mass. A second phase of reduced caloric intake is designed reduce subcutaneous fat, while, during the last week of preparations, extreme carbohydrate intake aims at loading muscles with glycogen. Simultaneously, sodium and water restriction results in extracellular and therefore subcutaneous volume deficit and better "definition" of muscle contours and structure. In the course of these dietetic manipulations a young body builder develops hypokalemia, hypophosphatemia, rhabdomyolysis and flaccid tetraparesis. The disturbances are pathophysiologically predictable.

164 patients (m = 45, w = 119; age 55.7 +/- 14.7 years) took part in a multicentric controlled parallel-double blind study in which efficacy and tolerability of the combination quinine sulfate (CAS 6119-70-6) plus theophylline ethylene diamine (CTED, CAS 317-34-0) (Limptar) in the treatment of the recurrent nocturnal leg cramps were investigated. Only patients who suffered before the begin of the study in at least three nights per week from leg cramps were included. The duration of the study was three weeks. In the first week all patients were treated in a single blind design with placebo. The subsequent 2 weeks were carried out double-blind. The global efficacy judged by the physicians and investigated for the 126 patients who took the compounds at least four days within the random phase was remarkably better for the combination than for quinine or placebo (very good and good in 87.1 vs. 63.7 vs. 39.5% of the cases; p less than 0.001; x-test). In 117 patients an analysis of the time course of the efficacy could be done from the notes in the diary (minimum duration of treatment 11 d). Already within the first week there was a highly significant decrease of nights with leg cramps within the CTED group (n = 34) from 4.68 (95% confidential interval 2.26-7.0) to 2.25 (0-6.78) in comparison to placebo (n = 40; from 4.32 [1.9-7.0] to 3.69 [1.22-6.91]) and quinine (n = 43; from 4.78 [2.22-7.0] to 3.27 [0-7.0]; F-test; p = 0.0001 resp. 0.0012).(ABSTRACT TRUNCATED AT 250 WORDS)

Although pain is not considered a typical symptom of multiple sclerosis, more than 50% of patients with MS present with pain syndromes. In the setting of an incurable disease, symptom control and particularly pain control is very important in achieving a better quality of life. For paroxysmal pain syndromes such as trigeminal neuralgia or painful tonic seizures, carbamazepine and other anticonvulsive drugs are the cornerstone of treatment. On the other hand, drugs are not always effective in treating the various chronic pain syndromes such as dysesthetic extremity pain or leg spasms. In these conditions, individualized regular physiotherapy may relieve pain.

Investigations about Hoffmann reflex of M. triceps surae on both extremities were carried out on 10 young volunteers before and after cryoapplication of ten minutes on the left leg. Determination of H/M ratio indicates the influence of cold application on muscle tonus, which was decreased on the treated side without any influence on the contralateral. The results support the view that muscle relaxation depends on decrease of muscle temperature.

1500 bronchoscopies performed in the Department of Pneumology, University of Basle, were analyzed for frequency and severity of complications. 500 patients were investigated by rigid tube in local anesthesia, 500 patients by rigid tube in neuroleptanalgesia and 500 patients by flexible fiberbronchoscope. The rate of complication for all patients was 4.1%, which agrees well with the previously reported complication frequency of 1-11%. The complications were minor in 3.5% of patients, moderate in 0.5% and major in 0.1%. There were no deaths. The incidence of severe complications and deaths was thus lower than in other studies. There was a higher incidence of complications (p less than 0.001) in the group examined with the rigid tube in neuroleptanalgesia, due to the more frequently observed minor complications. The incidence of complications can be reduced by a careful indication for bronchoscopy, adequate yet sparing use of anesthesia, and choice of the right instrument.

The efficacy of parenteral Mg therapy for pre-eclampsia and eclampsia is due to the Mg antagonism of Ca ions. Accordingly, the Mg additional treatment of medicamentous tocolysis reduces the risk of an over-increased cardial energy consumption; at the same time Mg has an effect which inhibits uterine contractions. The favourable effects on the nocturnal calf cramps are due to the compensation of a combined Mg and Ca deficiency and/or a membrane stabilisation caused by Mg. In animal experiments all reproduction processes were negatively influenced by Mg deficiency, whilst the rate of abortions in early and late pregnancy as well as premature births decreased in pregnant women after administration of Mg. The perinatal mortality is similarly favourably influenced. Since prophylactic oral Mg application is effective and safe, it can be recommended without reservations.

The paper gives the results of a follow-up study of 58 patients after psychotherapeutic treatment as in-patients for writer's cramp. Where as immediately after discharge 74.1% of the patients felt an improvement in their condition, at the time of the follow-up study only 17.2% were demonstrably improved, with 37.9% subjectively feeling an improvement over their state before treatment as in-patients. These results suggest that the customary psychotherapeutic methods employed have less effect on the evidently multifactorial extrapyramidal-motor basic complaint but rather have the effect of improving the patient's ability to cope with this in daily life.

We determined serum magnesium(Mg)-levels in 67 pregnant women in late pregnancy. 42 gravidae complained of nightly muscle cramps; 21 of them received 1.8 g monomagnesiumaspartate twice daily per mouth for 4 weeks. 2 and 4 weeks after the initiation of therapy serum Mg-levels were again determined. Serum Mg-levels were lower in pregnant women as compared to a control group of non pregnant women. Gravidae complaining of muscle cramps had significantly lower serum Mg-levels than women without muscle cramps. The administration of Mg was associated with a significant rise in serum Mg-levels as early as 2 weeks after the initiation of therapy. Our study indicates that nightly muscle cramps during pregnancy might be a sign of a latent magnesium deficiency which can be influenced by oral magnesium.